Provider Demographics
NPI:1679881288
Name:LEWIS, ALISON M (MA CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:ALISON
Middle Name:M
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:MRS
Other - First Name:ALISON
Other - Middle Name:M
Other - Last Name:WEIGAND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:104 ASCAN AVE
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-6014
Mailing Address - Country:US
Mailing Address - Phone:917-232-5136
Mailing Address - Fax:
Practice Address - Street 1:2626 75TH ST
Practice Address - Street 2:
Practice Address - City:EAST ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11370-1427
Practice Address - Country:US
Practice Address - Phone:718-330-3272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-16
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015161-1235Z00000X
NY12040265235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist